CATHARSIS RECONSIDERED David Straton Mainstream psychiatry and psychotherapy have held for many years that cathartic psychotherapies involving powerful emotional expression have limited value. The conventional wisdom is that they are either dangerous, or ineffective, or that their effectiveness is short-lived. This paper reviews the origins of this conventional wisdom and makes two findings. Firstly, that there is remarkably little serious research into cathartic psychotherapies, but what there is tends to support catharsis. Secondly, that the periods in the last 200 years when cathartic methods have fallen into disrepute have often coincided with threatened or actual scandals involving prominent practitioners of cathar- tic psychotherapy. Four models of catharsis are described; the “Hydraulic”, the “Pavlovian”, the “Cathexis”, and the “Holographic”. The discussion sug- gests situations in which catharsis would be likely to prove useful, and indicates potential risks. Australian and New Zealand Journal of Psychiatry 1990; 24543-551 The field of cathartic psychotherapy has been psychoanalytic psychotherapy. A common reaction thoroughly reviewed in two books by Nichols and his from psychiatrists and conventional psychotherapists associates, “Catharsis in Psychotherapy” [ 11 and has been that “catharsis was tried by the grand old “Emotional Expression in Psychotherapy” [2]. pioneers of psychotherapy and found wanting.” In the Another review by Kellerman [3] covers its place in absence of a significant literature of empirical evalua- psychodrama. As one of these [2] wrote, “If the ex- tion to support such a guilty verdict, it is interesting to pression of powerful feelings is therapeutic, then one know how such a conclusion arose. should be able to demonstrate it empirically and ex- plain it with an adequate theoretical rationale. Unfor- History tunately, neither the evidence nor the rationale is yet available.” They went on to describe the evidence The history of catharsis goes back to the temples in available as “meagre”, yet that which exists tends “to ancient Egypt and to classical Greece. Aristotle dis- support the utility of catharsis as a vehicle for behavior cussed it in his “Poetics”, and it undoubtedly played change”. an important part in many different religious rituals In the last two or three decades there has been a throughout the ages. Its use in modem psychotherapy resurgence of cathartic methods of therapy or “per- can be traced to 1775, the time that Ellenberger (41 sonal growth” in the context of the “Human Potential” cites as the birth of dynamic psychiatry. He described movement. These alternative therapies have arisen in Father Johann Gassner (1727-79) as one of the most competition to conventional psychiatric treatments famous healers of all time. A priest, he was a skilled such as psychopharmacology and behavioural or exorcist who attracted huge numbers of people to Ellwangen, a small town in southern Germany. He would command the demon possessing an afflicted Post Office Box lSSS,Broadbeach, Queensland person to produce the symptoms of the disease. In David Straton MB,ChB, DPM. FRANZCP suitable cases this would happen, and Gassner would 544 CATHARSIS RECONSIDERED then further instruct the demon to produce convulsions foreshadowed the verbal/action split that has been a and emotional manifestations. Once fully tamed, the recurring issue in psychotherapy since. He discovered demon would be cast out in a ‘‘crisis”. a particular type of crisis, the “perfect crisis’’, charac- The controversy which erupted may have occurred terized by somnambulism, the ability to talk lucidly because of the emergence of the Enlightenment, which about delicate matters, and subsequent amnesia. Con- was attempting to replace blind faith and superstition vulsions did not occur. Puysegur rejected the magnetic with Reason. Demons, possession and exorcism were fluid theory, believing that magnetic sleep was the shunned. In 1775 several inquiries were held into result of a psychological force between magnetizer Gassner, as a result of which his activities were severe- and patient. From 1785, a rift developed between the ly restricted. The inquiry in Munich featured an expert followers of Mesmer, who believed that magnetic witness called Dr Franz Mesmer. sleep was only one of many forms of crisis, and Mesmer ( 1734- 18 15) was able to reproduce Puysegur’s school. The latter group prevailed, though Gassner’s cures, but he claimed it was through “animal the distinction was obscured by the use of the term magnetism”, not exorcism. He was a doctor from “mesmerizing” by Puysegur’s followers. Much later, Vienna who had married a wealthy noble widow with in 1843, it became known as hypnosis. a magnificent estate. Mozart’s first opera was per- The next significant development occurred near the formed in a private theatre in their garden. Mesmer’s end of the nineteenth century. After a time when dissertation had been on the influence of planets on hypnosis had been shunned by the medical estab- disease, and he attempted initially to reproduce tidal lishment, the eminent neurologist Charcot ( 1825- forces by the use of magnets attached to his patients. 1893) succeeded in making it once more a respectable Later he developed a wide variety of techniques for subject for study. Amongst those stimulated to use it “shifting fluids” in the body, some of which were were Breuer and Freud. Their book “Studies on similar to Gassner’s. One technique was to sit in front Hysteria”, published in 1895, includes the celebrated of the patient with his knees touching the patient’s case of “Anna 0.” as well as Freud’s views on the knees, press her thumbs, stare into her eyes, and then cathartic method [5]. This involved hypnotizing the press on her hypochondrium. When successful, a patient, encouraging her to concentrate on the “crisis” would occur. If repeatedly provoked, the symptom and then recount the experiences that had crises would become less severe and eventually disap- produced it. Much has been written about Breuer and pear. This he interpreted as recovery. Anna 0. [6-101. It is not clear from the case history Mesmer was no stranger to controversy. In 1777 he precisely how he induced the hypnotic state, nor the left Vienna after a scandal involving a young woman extent to which the “catharsis” was an emotional patient. He moved to Paris and established a lucrative abreaction, or a more gentle verbal report. What is practice. It was so busy he began treating groups of known is that the treatment involved Breuer at times about 200 at a time. A society was founded to spread visiting his attractive patient’s bedside twice daily to his ideas. Some of these were somewhat grandiose, for close her eyes at night and open them in the morning, instance he once claimed that running water was mag- his identity being confirmed by her feeling his hands. netized because he, Mesmer, had magnetized the sun! It is also said that when he terminated the treatment on In 1784, the agitation around Mesmer led King account of his wife’s jealousy, Anna 0. developed an Louis XV1 to establish an inquiry into his activities. hysterical childbirth which she claimed was a preg- The commission included Lavoisier, the famous nancy from Breuer [9]. He panicked, put her into a chemist, and Benjamin Franklin, who first proved the trance, and fled the house. This event led him to delay electrical nature of lightning, at that time the American publication of the case for 13 years and eventually ambassador in Paris. The report stated that no evidence played a part in his abandoning his work with Freud could be found of a “magnetic fluid”. A supplementary [Ill. report warned of the dangers of a magnetized female Freud continued to believe in the cathartic method, patient developing an erotic attraction for her male although he found hypnosis difficult [ 121. He experi- magnetizer. mented with other approaches, including suggestion, It was one of Mesmer’s disciples, the Marquis de massage [ 131, pressure on the head, and free associa- Puysegur (1751-1825), who made a discovery that tion. He finally stopped using hypnosis in 1896 [14], changed the direction of Magnetism, and after a female patient threw her arms around his neck DAVID STRATON 545 on awaking from a trance. A servant walked in at the whatever the logical status of the idea, it serves an same moment [ 151. important function in protecting the analyst from dis- Freud’s shift from cathartic therapy to free associa- turbing feelings in the patient. According to Freud, tion and psychoanalysis was complicated, and the these played “an undesirably large part in ..... cathartic record contains enough diverse information to support analyses” [20]. a number of different interpretations. The mid 1890s Although Freud and his followers stopped using saw several important changes and events in his life, hypnosis and catharsis, others did not. Janet, who had including his dream of Irma’s injection in July 1895 also worked with Charcot and became Freud’s main (with its implication of emerging doubts about his rival in France, claimed to have discovered the cathar- friend Fliess), the writing of his “Project for a Scien- tic technique before Breuer. In 189 I, he introduced tific Psychology” in September 1895, and a general “automatic talking” and incidentally also devised a loss of interest in therapy in favour of psychology and technique for modifying visual images under hypnosis philosophy [16]. His subsequent emphasis on the which bears a striking resemblance to what is currently method of free association and the analysis of dreams called Neuro-Linguistic Programming [2 I]. Other and resistances may also have been influenced by the aspects of Janet’s approach remind the modem reader death of his father in 1896, and his own neurosis and of Milton Erickson [22] and Ida Rolf [231. self- analysis [ 171.